Glucocorticoid and Opioid Use Need to Be Optimized in Patients With Rheumatoid Arthritis

Further efforts are needed to optimize glucocorticoid and opioid prescribing for patients with rheumatoid arthritis (RA) in order to improve patient outcomes, according to study findings published in Current Opinion in Rheumatology.

High-quality clinical trials have established that glucocorticoids improve outcomes in RA, the study authors noted, but whether their benefits outweigh their risks continue to be questioned. Therefore, researchers reviewed recent studies on patterns of glucocorticoid and opioid prescribing in RA, and associated harms. They found that, currently, a large percentage of patients with RA remain on glucocorticoids and/or opioids long term, and the likelihood and risk for both glucocorticoid and opioid exposure varies across the population and are influenced by provider factors.

Chronic opioid use has recently increased among patients with RA despite its inability to effectively modify RA-related pain or reduce disease activity, and opioid exposure is associated with delays in disease-modifying treatment initiation in patients with RA. Evidence increasingly demonstrates toxicity associated with even low-dose glucocorticoids (≤7.5 mg/day), however up to two-thirds of patients with RA may be able to discontinue chronic low-dose glucocorticoids without flare or adrenal insufficiency. Thus, these new data have led to changes in clinical practice guidelines for glucocorticoid use in treating RA as the risks for using glucocorticoids to maintain disease control in RA appear to outweigh the benefits.

The study authors concluded, “Although low-dose and short-term glucocorticoid use is extremely common and effective in RA management, increasing evidence of toxicity has led experts to begin recommending that such exposure be minimized.” They added, “Despite a lack of data to suggest opioids improve RA disease activity, they are used commonly, continued long-term, and associated with delayed effective therapy.”

Reference

Moore MN, Wallace BI. Glucocorticoid and opioid use in rheumatoid arthritis management. Curr Opin Rheumatol. 2021;33(3):277-283. doi:10.1097/BOR.0000000000000788